Preventing Falls with STEADI: Practical Steps for Clinicians

As PTs and OTs, we understand the personal, functional, and financial impact of a fall on our patients’ lives. Implementing effective fall prevention strategies, like those outlined in the STEADI toolkit, is crucial, as the consequences can range from a fear of falling again to prolonged rehabilitation or even a greater reliance on assistance at home.

The statistics surrounding falls among older adults also emphasize the need for effective fall prevention. According to Kakara, et al. (2023), one in four older adults in the United States will fall every year, and falls are the leading cause of injuries in this population, including hip fractures and traumatic brain injuries. Moreland, et al. (2023), further highlight that in 2019, 83 percent of hip fracture deaths and 88 percent of emergency department visits and hospitalizations for hip fractures were the result of a fall.

However, despite these alarming statistics, there is a lot we can do to prevent falls. By making simple adjustments to our clinical practice and fostering partnerships with healthcare providers and community organizations, we can significantly improve outcomes for our older adult patients.

Taking Action with STEADI: Your Guide to Fall Prevention

This year, from September 23rd to 27th, the National Council on Aging (NCOA) is spearheading Fall Prevention Awareness Week—a nationwide effort to raise awareness and promote action to prevent falls among older adults. The theme for 2024, “From Awareness to Action,” serves as a timely reminder to evaluate our clinical practice patterns and identify areas for improvement in fall prevention strategies.

One effective way to enhance our fall prevention efforts is by utilizing the STEADI toolkit, developed by the CDC. The toolkit offers a range of free tools designed to help clinicians screen, assess, and intervene in fall risk, providing a structured framework to support better patient outcomes.

Assessing the effectiveness of these tools in clinical settings is crucial. Alongside several other experts, including Mariana Wingood (a fellow MedBridge instructor and member of the Medical Expert Panel for Pathways), I co-authored a study that evaluated the implementation of the STEADI initiative across 34 outpatient rehabilitation clinics. While the study showed significant reach and effectiveness, especially among physical therapists, our findings highlighted the need for ongoing support and innovative strategies to sustain and enhance the positive outcomes of the STEADI initiative in these settings.

Now let’s focus on actionable steps you can take to implement the STEADI initiative principles in your practice.

Find Your Partners: Internally and Externally

Falls typically result from a combination of multiple risk factors, including physical, environmental, and behavioral components. Managing these risks can be challenging, making it essential to have a team of professionals to collaborate with. The STEADI toolkit acknowledges the value of a multidisciplinary approach to fall prevention, recognizing the critical roles that various professionals play in managing fall risk.

• Collaborate with PTs and OTs: If you’re a physical therapist, partner with an occupational therapist, and vice versa. PTs and OTs are excellent rehab partners who can work together to address the physical aspects of balance, gait, and strength, as well as home safety, cognition, and the fear of falling.
• Connect with Geriatric Medicine Professionals: Whether it’s a geriatrician, geriatric nurse practitioner, or a primary care physician with a focus on geriatrics, having a knowledgeable medical professional who understands fall risk is crucial. These professionals can help manage medical conditions like orthostatic hypotension or depression, which are often associated with fall risk.
• Partner with Community Fitness Instructors: Engaging community fitness instructors who specialize in evidence-based fall prevention programs, such as Tai Chi, can help keep your older adults motivated and actively managing their fall risk outside the clinic.
• Collaborate with Specialists: Build connections with professionals in podiatry, optometry, and pharmacy. These experts can provide valuable insights and referrals that address various aspects of fall prevention.

Standardize Screening

Screen all older adults, regardless of their initial diagnosis, to identify those at risk for falls. Incorporating the Stay Independent screening brochure into your standard intake paperwork for new evaluations is a simple yet effective strategy. This brochure helps quickly assess risk factors, making it an integral part of your screening process. 

Additionally, integrating the Stay Independent Questionnaire into your electronic health record (EHR) can streamline the documentation and communication of fall risks with other providers, ensuring that risk factors are consistently monitored and addressed throughout the course of care.

Simplify Clinical Workflow

Incorporating fall prevention into your practice doesn’t have to be a cumbersome process. By streamlining your clinical workflow, you can integrate effective fall prevention strategies seamlessly into patient care without overwhelming your team. 

The key lies in making tools and resources easily accessible, allowing for flexibility in how you approach each patient’s unique needs. By standardizing certain processes, such as screening at initial visit, and leveraging available resources, you can create a more efficient and effective approach to fall prevention, ensuring that it becomes an integral part of your routine care rather than an added burden.

Make Patient Educational Accessible

Ensure that fall prevention education is convenient and easily accessible. MedBridge’s comprehensive patient education library offers both printable handouts and informative instructional videos, which you can preview with your patients to answer any questions and make sure they understand the material. Below, you can watch “How to Get Up After a Fall,” an example of what MedBridge’s patient education library offers. The video teaches patients how to get up safely to help avoid making an injury worse.

These resources are designed to meet patients’ needs and can be included in their home exercise programs. They provide practical and visual guidance to help patients better understand and engage with their care plans. Using these tools ensures that patients can easily access important fall prevention information.

Allow Flexibility in Assessment and Interventions

While STEADI provides a solid framework, it doesn’t dictate how PTs and OTs should address and assess fall risk. Flexibility in your approach allows you to use your clinical judgment in assessing and addressing fall risk factors within each patient’s plan of care. This is particularly important when dealing with patients who present with non-fall-related issues, such as a shoulder injury or back pain.

Build Rapport to Facilitate Behavioral Change

Establishing a strong rapport with your patients is essential for encouraging the behavioral changes required to reduce fall risk. By connecting these changes to what matters most to your patients—such as maintaining independence or engaging with family—you can help them see the value in adhering to fall prevention strategies.

Staying Ahead: Continuous Learning and Patient Involvement in Fall Prevention

As clinicians, our role in fall prevention extends beyond the immediate care we provide in the clinic. Continuous learning and staying updated on best practices are essential for effectively managing fall risk among our older adult patients. 

By utilizing comprehensive fall prevention strategies and educational tools available to healthcare professionals, we can ensure that our approach to fall prevention remains both current and effective. Additionally, providing patients and caregivers with access to reliable information and strategies can empower them to take an active role in reducing fall risk.

References

1. Kakara, R., Bergen, G., Burns, E., & Stevens, M. (2023). Nonfatal and fatal falls among adults aged ≥65 years—United States, 2020–2021. MMWR Morbidity and Mortality Weekly Report, 72, 938–943. https://doi.org/10.15585/mmwr.mm7235a1
2. Moreland, B.L., Legha, J.K., Thomas, K.E., & Burns, E.R. (2019). Hip fracture-related emergency department visits, hospitalizations and deaths by mechanism of injury among adults aged 65 and older, United States 2019. Journal of Aging & Health, 35(5-6), 345-355. doi:10.1177/08982643221132450
3. Vincenzo, J.L., Caulley, J., Scott, A.J., Wilson, B.S., Wingood, M., & Curran, G.M. (2023). Integrating STEADI for falls prevention in outpatient rehabilitation clinics: An outcomes evaluation using the RE-AIM Framework. The Gerontologist, 64(4), gnad117. doi.org/10.1093/geront/gnad117.